| NPI | 1790800746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC30419) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: CA AC 11793) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2010-12-03 |